International Academic Institute for Science and Technology International Academic Journal of Organizational Behavior and Human Resource Management Vol. 2, No. 9, 2015, pp. 33-39. ISSN 2454-2210 International Academic Journal of Organizational Behavior and Human Resource Management www.iaiest.com The impact of nurses' empowerment and decision-making on the care quality of patients in healthcare reform plan Zahra Jalali* a, Ali Shaemi b a Master of MBA, Isfahan University, Working in organizational development and human resource management, Isfahan University of Medical Sciences. b Management PhD, professor of management and economics at the University of Isfahan. Abstract The central role of empowerment in health programs and the importance of healthcare workers, as a bridge between their community and health care system, and due to the increase of the authority of this stratum of society, in order to improve public health in the new health plan, is of great importance. The aim of this study was to analyze the impact of nurses' empowerment and decision-making on the care quality of patients in the healthcare reform plan, and then to develop strategies to improve and empower health employees, followed by the better quality care. The research is descriptive and the standardized questionnaires with the five-item Likert were used. The study sample included 75 nurses and 75 patients in 2016 that were selected through simple random sampling. In Cranach s alpha, nurses empowering was 0.92 and patient satisfaction was 0.89 respectively. PLS results showed that the calculated value of t greater than 2, and indicate the impact of nurses empowerment and decision-making on the care quality of patients, in health system reform plan is significance. Nurses empowering will explain 55 percent of the patient satisfaction variability. As well as nurses empowering is more than other factors affected on the quality of care. Keywords: nurses empowering, nurses' decision making, patient satisfaction, health system reform plan 33
Introduction: Today's organizations are due to factors such as increased global competition, rapid changes, the need for quality and after-sales service and limited resources are under intense pressure. After years of experience, the world concludes that if an organization wants to be a leader in economic and business affairs and does not fall behind the competition, needs expert, creative and high motivated resource. Human resources is constitute the real wealth of an organization. Environmental changes and increased global competition, has put employee empowerment on the spotlight of managers. Because organizations with empowered, committed, skilled and motivated employees will be better able to adapt to change and compete. Empowerment is considered as a way to increase decentralization, freedom and accountability of employees.given the central role of empowerment in health programs, and with regard to the importance of health staff as the bridge between the community and health care system, focus on increase of the authority of this stratum of society, in order to improve public health the new health plan is more important. Employee empowerment is directly affect on the quality of services provided and customer satisfaction. Nurses are the largest group of employees that provide the health service [13],[2].considers empowerment as the sharing of the front line staff in the four elements of information, knowledge, reward and power. Some have defined empowerment as a form of decentralization, which involves delegating fundamental decisions authority to subordinates[9].pakinson considers empowerment as a solution to the old problem of Brokranik and Tailorised organizations and companies, where creativity is ignored and workers both individually and collectively, by showing empty behavior, are alienated by themselves [11].Cameron has defined empowerment as a process of empowering the people. In the process, we help employees to improve their self-esteem, and accordingly dominate on weakness and helplessness. Empowerment in this sense is lead to mobilize internal people motivations [12]. Organizational learning is a process and a set of activities that lead to employees learning, and involve certain organizational behavior that apply in a learning organization. In such organizations all conditions provided for learning and people continuously members attaining to apply what they have learned [8].Saatchi and et.al suggest that organizational commitment is related to many job behaviors, including organizational commitment has potentially serious effects on the performance of the organization [10].Mostafavi Rad and et.al are conducted a study about organizational commitment, and concluded that empowering school teachers, strong school relationship, and autonomy for employees and teachers lead to more commitment to the organization [5].The main keys of globalization, is empowerment, motivation and education. Proper assessment or control requires an overall evaluation of the nursing, care, or units programs. One of the vital components in this way is quality management programs. The main key to quality management is continuous improvement. Due to increasing patients and care centers, there is a need to programs to improve the quality and application of standards to meet the needs and providing services. The initial default is that the nurse shall be accountable to providing care for client. Quality assurance programs in hospitals in the 1960s, has started with inspections of nursing. Quality assurance program was initially designed to execute nursing standards and specified indicators to assess the standards.quality control programs, quality assurance, quality improvement have been merged and enhanced service and customers satisfaction. To meet the service expectations according to customers' requirements leads to relationship between service quality and customer satisfaction. In other words, if customers feel that their need is fulfilled, they considered it as the quality of service. Customer satisfaction survey of services from quality assurance is vital in all programs. Clinical suffice nurses, is a key element in the ability and clinical 34
decision making, and itself derived from nurse' knowledge and clinical experience[1].nurse self-esteem is an essential element in effective clinical decision-making. White reported that nurses who had more confidence, have better control on their work and apply more effective and independently decisions for care of the patient. Other studies have shown that self-efficacy of a person has more affect on his/her performance than actual skills [3]. Research objectives The overall goal Determining the effect of empowering nurses on patient satisfaction in healthcare reform plan. Theories Thus, the hypotheses for this study are as follows. 1. Empowering nurses a significant and positive impact on patients' satisfaction. 2. Components respect, self-efficacy, self-optional, professional growth, significance, trust has positive and significant impact on patients' satisfaction. Research domain The study was carried out in the first half of 2016 at the Medical Center of Alzahra Hospital, and investigates and identifies the empowerment conditions of nurses and its impact on quality of care (patient satisfaction). Researcher in this study aim to identify the status of nursing staff ' empowerment components, and review its impact on quality of patients care in healthcare reform plan. Variables A) The independent variable is empowerment of nursing staff at Al Zahra Hospital Medical Center and the dependent variable of the study is patients' satisfaction in healthcare reform plan. Research method 35
This study is quantitative research in term of nature, in term of object is applied research and in term of research plan is descriptive-correlation of structural equation, and researched university medical centers' officials and managers can benefit from its results. Due to these results, medical center managers can benefit from its results in development of healthcare reform plan. In this study, the data collection will be both library and field method. To gather information on the history and literature (secondary information), the library method will be used. And in field research, questionnaires will be used to collect the views of nurses and patients (preliminary data), in order evaluate the impact empowerment of the nursing staff on patients' satisfaction in healthcare reform plan in Isfahan University of Medical Sciences. Information needed for this research is used from a standard questionnaire. The study population is comprise nurses who, are working in formal and contracted in obstetrics and gynecology department, transplant section, CCU and emergency of Alzahra Hospital that estimated 95 people.the questionnaire is collected in 2016. According to Morgan, the sample volume table was estimated about 76 people at 95 percent confidence level. To set the questionnaire, according to information obtained from the research conducted, the preliminary questionnaire was prepared and after approved by the supervisor, was distributed between the number of nurses working in hospitals and the number of hospitalized patients. Finally, the final questionnaire included 34 questions with five valued options is prepared, and distributed between the number of nurses working in hospitals and the number of hospitalized patients. Factor analysis: KMO index and Bartlett's test The KMO index was measured and was variable between zero and 1, because KMO value was higher than 0.6 we used factor analysis.bartlett's test significant level was smaller than 0.05, so questionnaire validity was confirmed. Table 1. KMO and Bartlett's sphericity test results for questionnaire KMO scale test of 0.718 ampling adequacy. Sig Bartlett's sphericity test To determine the reliability of the model in this way, the three criteria Cronbach's alpha, combined reliability, load factor coefficient, convergent validity and divergent validity criteria were used. All questions relating to the survey are more than 0.4, which indicates the suitability of this measure. Cronbach's alpha and composite reliability: Cronbach's alpha coefficient for all variables is more than 0.7, so reliability is acceptable. Divergent validity: In PLS, it is done by a matrix, which the matrix cells contains a correlation coefficient between structures and AVE root values for each structure. If the numbers in the diagonal are more underlying values, the validity is accepted. After studies down, it is showed that the amount of AVE root of all structures was more than correlation values between the structures, thus it can be stated that: In the present study, structures (latent variables) in the model have more interaction with their indicators than the other structures. In other words, the validity of the model is in appropriate volue. Results are listed below: Table 2. Matrix that assess the validity of divergent validity based on the model by Fornell and Larkr the of professionals 36
Satisfaction autonomy affecting decisionmaking selfdevelopment Professional s growth respect International Academic Journal of Organizational Behavior and Human Resource management, respect 0.73 Professionals growth 0.71 0.71 selfdevelopment 0.60 0.67 0.85 affecting 0.65 0.70 0.43 0.76 decisionmaking 0.71 0.69 0.54 0.55 0.75 autonomy 0.65 0.70 0.65 0.49 0.68 0.73 Satisfaction 0.51 0.52 0.37 0.40 0.46 0.39 0.73 The hypothesis analysis Given that a significant coefficient Z between the empowerment of nurse's variables on patients' satisfaction was more than 1.96, it is approved in significant level of 95%. β coefficient between these two pathways also suggests that the empowerment of nurses, will determine 55% of the patient satisfaction variability. The results of this test are shown in Figure 2. Figure 2. Research model with standardized loadings coefficients The values of t at the significant level of 95% are in the table below: Table 7. The values of t' results P values standard error T value Variables 37 Satisfaction
*P < 0.05 0.026 0.012 0.044 0.050 0.029 0.050 0.068 33.968 78.968 16.482 14.701 30.132 16.145 8.187 respect Professionals growth selfdevelopment affecting decision-making autonomy Satisfaction Discussion and conclusion Given the central role of empowerment in health programs, and the importance of healthcare workers as the community bridge between themselves and health care system, focus on increasing competencies of this segment of society has more critical importance in order to improve public health in the new health plan [13]. Dynamic and changing conditions governing the work environment of nurses, with uncertain and variable status of patients, requires that they be competent decision makers, so that they can combining their technical skills and professional knowledge, and take accurate and convenient clinical judgments regarding to the health status of patients. And while operating in a multi-disciplinary team, diagnose and solve problems of patients in nursing [14].The results of this study, which aims at analyzing the impact of nurses' empowerment and decision-making on the quality of care of patients in health system reform plan, and review of the study, according to data compiled by statistical tests, showed that empowerment impact on patient satisfaction, and will has the greatest influence on satisfaction of the patients among these aspects of professional growth.therefore, it is suggested that the professional growing importance of nursing is considered as a major priority for health promotion and patient satisfaction as the most important part of health system clients. And with the newest treatment methods to nurses and motivate them, effective steps are taken to improve the community health level. Clinical suffice of nurse (professional development), is a key element in clinical decision making ability and itself derived from nursing knowledge, skills and clinical experience. These findings have been confirmed in other studies [4].PLS results showed that the calculated value of t greater than 2, and indicate the impact of nurses empowerment and decision-making on the quality of care of patients, in health system reform plan is significance. Given that a significant coefficient Z between the empowerment of nurse's variables on patients' satisfaction was more than 1.96, it is approved in significant level of 95%. β coefficient between these two pathways also suggests that the empowerment of nurses, will determine 55% of the patient satisfaction variability.empowering nurses is affected more than each other factor on the quality of care. Sub-components, such as respect 0.48, Professional growth, 0.52, self-efficacy 0.40, influence 0.41, Decision 0.48 and self-determination 0.45 are affected on patient satisfaction.as a result, all the 38
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